Disclaimer: this article focuses on the social and psychological aspects of infertility in America. For information regarding the biological aspects of female infertility click here.
According to the Centers for Disease Control (CDC), approximately 10% or 6.1 million women in the United States struggle with infertility, which is understood as the inability to conceive or carry a pregnancy to term after 12 months of trying or 6 months if the woman is over 35 years old 2. Infertility is not only a physiological disorder that affects a woman’s ability to become pregnant but it also impacts her psychological and social well-being. Women who are infertile often face a variety of external and internal pressures imposed by cultural norms and expectancies. These pressures are recognized as (but not limited to) stigmatization as well as psychological distress. This article will further discuss how society and culture influences public views of infertile women, ways in which infertile women cope with such pressures, and useful resources for infertile women.
The Importance of Motherhood
The stigmatization of infertility lies in the social importance of motherhood in a given culture. For this reason, it is necessary to examine the social construction of the institution of family, along with the gendered social roles assigned within it. Stressing the cultural importance of motherhood, Elizabeth Sternke of Perdue University finds that despite a myriad of cultural and social changes in expectations for women in the 20th century, pregnancy and motherhood have retained their priority over other roles for women in the U.S. today 4. Infertility directly affects a woman’s ability to become pregnant and in turn affects her ability to become a biological mother. This inability to become a biological mother is where pressures to fulfill assumed gendered roles derive from. Sternke notes that recent studies on women and infertility indicate that women and their bodies are marginalized and viewed as materially and symbolically deviant when they cannot or do not become pregnant and give birth to children 4. The reason infertile women and their bodies are viewed in this way is the expectation that all women have the biological capacity to reproduce. Often, infertile women are seen as socially undesirable because they cannot fulfill the role of a mother in the traditional nuclear relationship.
The importance of motherhood in America is a phenomenon that can be historically understood. The patriarchal social system that the U.S. was founded under still permeates many aspects of social life. When examining the social institution of the family, we see how patriarchy has influenced the way gender roles have been constructed. The traditional family model suggests that the male is the economic supporter of the family, while the female stays at home to care for her expected children. As a result, having children is understood as the epitome of feminine fulfillment, or the means by which women achieve full adult status and demonstrate their female identity 4. This result shows the importance of not only being a mother, but also what it means to be a mother.
Researchers Mueller & Yoder at the University of Akron, further find that across demographic characteristics, women who are mothers are more highly thought of by respondents than women without any children 4. The gendered role of motherhood must be further conceptualized to understand this analysis. Being a mother includes nurturing, protecting, and socializing their children. Women who are infertile then become alienated because they are deemed ‘incapable’ of such motherly roles or activities. These sorts of external social pressures to become a mother are where psychological distress stems from and will be the topic of discussion for the remainder of this article.
Psychological Distress Associated with Female Infertility
Psychological distress associated with female infertility is linked to social pressures that influence the way women view themselves in a society where biological motherhood is the expected gendered role for women. When women cannot fulfill these life roles, distress and feelings of failure can become a part of their daily experiences 3. Furthermore, some infertile women view the condition as a loss of experiences. Experiences lost include the loss of pregnancy and the entire childbirth experience, genetic legacy, parenting experience, stability in their ideal family or personal relationships, and typically include feelings of low self-worth and self-esteem 3. Psychological distress associated with infertility is complex and varies from person to person. The following information will cover the some of the situations that some infertile women may experience as well as provide resources to cope with related psychological distress.
While society pressures women to fulfill gendered roles as mothers, pressures within the individual to conform to such expectations create psychological distress as well. The influence here is more biological, with social aspects influencing the extent to which psychological distress is experienced. As humans, we are biologically programmed to reproduce with females holding the child carrying capacity. When women who want to have children experience infertility, the feeling is a sense of incompleteness or experiences loss. Even at an early age, many females dream of becoming a mother later in life. When women discover that they are infertile, there are many emotions that are associated with the loss of this ability to fulfill the expected role of motherhood. The psychological distress discussed here will focus on the emotions related to these losses experienced by infertile women.
There are many emotions related to the loss of experiences due to infertility including shock, depression, anger, and even lose their sense of control over their individual destiny and body 3. These emotions may be felt throughout the woman’s lifetime, however the crisis of infertility may be resolved over time through adoption, assisted reproductive technologies, or accepting to remain childfree 3. Strong support groups and psychological counseling, play a very important part in defeating negative feelings about infertility, which will be covered lastly in this article.
While there are many difficult situations to manage, most infertile women suggest grieving the loss of their unborn child is the hardest. Considering the biological and social pressures to become a mother, researchers find that many women who experience infertility have previously created fantasies about a child and their life with that child 3. When these expectations are not met, the result is a loss of those hopes and dreams, which creates a feeling of extreme grief 3. Researchers at the College of Education and Human Development, Ferland and Caron, find that women in their study grieved when they heard others comment on how much a child looked like their mother and then realized that would never be said to them or their child 3.
When infertile women experience these negative emotions, it is often due to these losses mentioned above. Considering these losses invisible increases the likelihood that they may not be discussed openly which can magnify the emotions felt by the women experiencing infertility and lead to a further sense of isolation 3. This is consistent with Sternke’s suggestion that stigmatized individuals isolate and separate themselves from others when the emotional and psychological pain of remaining in close proximity is too much to bear 4. Feeling this sense of isolation or alienation may come from situations such as attending baby showers, family gatherings, or weddings. This technique of managing proximity is often employed as an attempt to protect themselves from feelings of vulnerability, guilt, and shame 4.
When infertile women are stigmatized for not fulfilling motherhood expectations they often experience an attack on their identity. More so, Sternke suggests that the embodied identity, or the identity where there is an explicit and interactive link between the body and the mind, is singled out 4. In other words, the body assists in shaping the meaning of femininity, masculinity, parenthood, and adulthood 4. The argument is that the experience of infertility creates an awareness of this mind and body connection. This awareness is further correlated to how infertile women’s bodily experiences (not becoming pregnant as opposed to bodily changes during pregnancy) affected their identity, their relationships, and day-to-day lives. Fertile women are socially accepted as helping society run systematically and according to plan 4. Whereas infertile women are viewed as non-normative and this stigmatization holds the power to change individual lifestyles as well as change their deepest feelings about themselves 4. In response to such stigmatization and psychological distress, infertile women often employ defense mechanisms in an effort to manage and maintain a positive self-image. More so, they employ Ervin Goffman’s technique of impression management, wherein stigmatized individuals attempt to maintain as normal of an image as possible by disclosing little about the spoiled identity (infertile) in order to construct and maintain positive interactions with others 4.
However, infertile women manage different situations differently depending on their strategy of managing the information related to infertility. Some choose selective concealment, which includes informing close family members, close friends, or even co-workers about being infertile 4. Many infertile women choose this technique because they find that answering questions about their fertility status is too much of an emotional burden for them 4. On the other hand, women also cite the use of preventative disclosure, or telling everyone they know about being infertile in order to avoid painful situations such as others making socially inappropriate comments 4. Furthermore, preventive disclosure is employed to educate those around them. Therapeutic disclosure entails selective disclosure where people share their stories of their condition in order to gain emotional support and empathy, relieve frustration and anxiety and to negotiate their own perceptions about their own identity 4. Most commonly, infertile women interact with online or interpersonal support groups as a form of therapeutic disclosure. In these settings, infertile women are able to identify with others who have their same condition, have experienced similar situations, and can offer advice and education 4. Often, therapeutic disclosure is the most successful in resolving psychological distress felt from infertility.
We recognize that there is a significant amount of loss, grief, and hopelessness surrounding infertility, we do not want to suggest that these intense emotions experienced cannot be overcome. Research in this area has shown that many women are able to become mothers after a battle with infertility whether that is through becoming a biological mother, adoptive mother, or a mother in other ways 4. Advancements in modern technology have increased the number of infertile women willing to consider Assisted Reproductive Technologies (ART). However, these technologies are not always successful. RESOLVE finds that less than half the women under the age of 35 who use reproductive technologies are successful in becoming pregnant, and the success rate drops significantly as the woman ages, with only 12% success for women age 41 and 41 and only 5% for women age 43 and 44 1. Furthermore, ART is very costly and most are not covered by insurance, meaning patients must pay for it on their own. This finding suggests that while affluent individuals or couples may seek ART, many infertile women may find them economically unattainable, which can further feelings of psychological distress. The reason why we include this information is to show that infertile women have other ways of battling infertility instead of the misconception that to defeat infertility one must have a biological baby. The following information will include resources for infertile women seeking support and how this support assists in dealing with psychological distress.
RESOLVE, the largest national infertility advocacy and support organization in America, suggests that there are three psychological methods offered for individuals and couples experiencing infertility. These include individual or couples therapy, support groups, and mind and body groups. Each has its own strengths and weaknesses, and women seeking assistance through these methods should consider their unique situation and choose accordingly.
Individual or couples therapy focuses on the individual or the couple with the aim to create an open space to discuss their perceptions that relate to infertility. Individually, this can be useful in creating a better self-image. Couples therapy allows both individuals to communicate their feelings and expectations of one another. In most circumstances, the female expresses more distress regarding their infertility than her male partner 1. Through couples therapy, infertile women can clearly communicate to their partner how they would like to be helped and in turn their partner can learn a great deal.
As mentioned earlier, therapeutic disclosure can be an empowering act in which self-labeling as infertile creates a connection with other women, across time and space, which have experienced similar painful longing for a child that remains unfulfilled 4. Using support groups as an open space allows many women to create new relationships and find they are not alone in their struggle 4. These types of peer-to-peer support groups also serve as platforms, from which infertile women can begin to advocate for the fulfillment of their emotional, psychological, and physical needs 4. Through these interactions, women form bonds with each other and the relationships may expand into other valuable relationships 4. Similarly, online forums such as fertilethoughts.com allow for women to anonymously post and discuss all aspects of infertility. However, this online form of therapeutic disclosure lacks face-to-face interaction, which may work for or against some individuals.
While the resources above deal with interpersonal ways of dealing with the psychological distress related to infertility, there are also ways in which women can internally battle these negative emotions. Coping with stress is the number one way in which infertile women battle infertility. The mind and body method of dealing with infertility includes physical and psychological skills. Physical skills include relaxation or meditative techniques and information on lifestyle habits that influence fertility 1. Psychological techniques include cognitive restructuring, social support, and coping with negative emotions such as anger and guilt 1. These mind and body techniques teach infertile women tools and skills they can use to help themselves get their life back or feel like their “old self” again 1.
1. Domar, A. (n.d.). Infertility and Stress. Retrieved February 11, 2016, from http://www.resolve.org/
2. Infertility FAQs. (2015). Retrieved February 11, 2016, from http://www.cdc.gov/reproductivehealth/infertility/
3. Lindsey, Brandi, RN MSN CPNP: Driskill, Cynthia, RN MSN CPNP. International Journal of Childbirth Education 28.3 (Jul 2013): 41-47.
4. Sternke, Elizabeth Anne. Purdue University, ProQuest Dissertations Publishing, 2010. 3453386.
Last updated 2 March 2016